Pelvic anatomy

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Pelvic anatomy

  1. 1. Pelvic Anatomy www.freelivedoctor.com
  2. 2. Gynecologic Viscera <ul><li>Uterus: thick, muscular organ </li></ul><ul><ul><li>Derived from the fusion of the paramesonephric (mullerian) ducts. </li></ul></ul><ul><ul><ul><li>These ducts also form the upper 2/3 of the vagina and the fallopian tubes. </li></ul></ul></ul><ul><ul><li>Divided into 3 segments: fundus, lower segment and cervix. </li></ul></ul><ul><ul><li>3 layers: serosa, myometrium (smooth muscle), and endometrium. </li></ul></ul>www.freelivedoctor.com
  3. 3. Gynecologic Viscera <ul><li>Fallopian tubes: 10-14 cm in length, <1 cm in diameter. </li></ul>Isthmus - 1 mm in diameter - perfect spot for tubal ligation. Ampulla - 6mm in diameter - fertilization occurs here as well as most ectopics. www.freelivedoctor.com
  4. 4. Ligamentous Support <ul><li>Round Ligament: </li></ul><ul><ul><li>Fibrous and muscle tissue </li></ul></ul><ul><ul><li>Anterior to the fallopian tubes </li></ul></ul><ul><ul><li>Correlate with the male gubernaculums </li></ul></ul><ul><ul><li>They extend laterally, cross the external iliac vessels, and enter the internal inguinal ring, and insert in the labia majora. </li></ul></ul><ul><ul><li>Sampson’s artery, a branch of the uterine artery, runs along the length of the round ligament. </li></ul></ul>www.freelivedoctor.com
  5. 5. Ligamentous Support <ul><li>Broad Ligament: </li></ul><ul><ul><li>Double reflection of the peritoneum, draped over the round ligaments. </li></ul></ul><ul><li>Cardinal Ligament: </li></ul><ul><ul><li>Found at the base of the broad ligament. </li></ul></ul><ul><ul><li>Provides the main support for the uterus and cervix. </li></ul></ul><ul><ul><li>It attaches to the cervix and extends laterally, connecting to the endopelvic fascia. </li></ul></ul>www.freelivedoctor.com
  6. 6. Ligamentous Support <ul><li>Uterosacral Ligaments: </li></ul><ul><ul><li>Provide minor cervical support. </li></ul></ul><ul><ul><li>Originate from the upper posterior cervix, travel around the rectum bilaterally, and fan out to attach to the 1st - 5th sacral vertebrae. </li></ul></ul>www.freelivedoctor.com
  7. 7. Gynecologic Viscera <ul><li>Ovaries: </li></ul><ul><ul><li>Supported along the lateral pelvic sidewalls by the ovarian ligaments (attaching to the posteriolateral aspect of the uterus), the mesovarium (anastomotic region of the uterine and ovarian vessels), and the infundibulo-pelvic ligament (“The IP”), which are reflections of the broad ligament attaching the ovaries to the lateral pelvis. </li></ul></ul>www.freelivedoctor.com
  8. 8. Ovaries <ul><li>They rest in the ovarian fossa, immediately adjacent to the iliac vessles and the ureters. </li></ul><ul><li>They contain 3 distinct cell populations: </li></ul><ul><ul><li>Germ cells </li></ul></ul><ul><ul><li>Stromal cells - tightly packed around developing follicles and secrete hormones. </li></ul></ul><ul><ul><li>Epithelium </li></ul></ul>www.freelivedoctor.com
  9. 9. Bladder and Rectum <ul><li>Don’t forget they are close by… </li></ul><ul><ul><li>Bladder is anterior to the uterus. </li></ul></ul><ul><ul><li>Ureters originate in the renal cayxes and insert in to the inferior bladder at the trigone. </li></ul></ul><ul><ul><ul><li>Careful attention to the ureters path in the pelvis is essential for dissection in gynecologic surgery. </li></ul></ul></ul>www.freelivedoctor.com
  10. 10. www.freelivedoctor.com
  11. 11. Key Points of the Ureter <ul><li>In the pelvis the ureter runs medial to and parallel with the internal iliac artery. </li></ul><ul><li>Uterine artery crosses over the ureter (water under the bridge). </li></ul><ul><li>The remaining 2-3cm of the ureter passes through the cardinal ligament into the bladder. </li></ul>www.freelivedoctor.com
  12. 12. Rectum <ul><li>Lies posterior to the uterus following the curvature of the sacrum. </li></ul>www.freelivedoctor.com
  13. 13. Blood Supply <ul><li>Majority originates from the internal iliac artery (aka: hypogastric artery). </li></ul><ul><ul><li>Additional supply comes from the ovarian arteries, the inferior mesenteric artery, and the external iliac artery. </li></ul></ul>www.freelivedoctor.com
  14. 14. <ul><li>Common iliac --> external and internal iliac </li></ul><ul><ul><li>External becomes the femoral artery </li></ul></ul><ul><ul><li>Internal iliac --> anterior and posterior divisions </li></ul></ul><ul><ul><ul><li>Posterior division - rarely seen in pelvic surgery, has three branches that supply the gluteal region: </li></ul></ul></ul><ul><ul><ul><ul><li>Superior gluteal </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Iliolumbar </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Lateral sacral arteries </li></ul></ul></ul></ul>www.freelivedoctor.com
  15. 15. <ul><li>Anterior division: </li></ul><ul><ul><li>Uterine </li></ul></ul><ul><ul><li>Vaginal </li></ul></ul><ul><ul><li>Superior, Middle, and Inferior Vesicals </li></ul></ul><ul><ul><li>Middle and Inferior Rectal </li></ul></ul><ul><ul><li>Obturator </li></ul></ul><ul><ul><li>Inferior gluteal </li></ul></ul><ul><ul><li>Internal Pudendal </li></ul></ul><ul><ul><li>Obliterated umbilical arteries </li></ul></ul>www.freelivedoctor.com
  16. 16. <ul><li>During retroperitoneal surgery the primary branches identified are the: </li></ul><ul><ul><li>Superior vesical artery </li></ul></ul><ul><ul><li>Uterine artery </li></ul></ul><ul><ul><li>Obturator artery </li></ul></ul>www.freelivedoctor.com
  17. 17. <ul><li>Ovarian arteries </li></ul><ul><ul><li>Originate directly from the aorta, inferior to the renal arteries. </li></ul></ul><ul><ul><li>Most frequently identified at the IP ligament. </li></ul></ul><ul><li>Ovarian veins: </li></ul><ul><ul><li>Left ovarian vein drains into the left renal vein </li></ul></ul><ul><ul><li>Right ovarian vein drains directly into the inferior vena cava. </li></ul></ul>www.freelivedoctor.com
  18. 18. Lymph Drainage <ul><li>Cervical Cancer: </li></ul><ul><ul><li>Drains 1st to the parametrial nodes --> obturator nodes --> pelvic nodes --> para-aortic </li></ul></ul><ul><li>Uterine Cancer: </li></ul><ul><ul><li>Drains 1st to the pelvic nodes or para-aortic. </li></ul></ul><ul><li>Ovarian Cancer: </li></ul><ul><ul><li>Can metastasize to either the pelvic or para-aortic nodes. </li></ul></ul>www.freelivedoctor.com
  19. 19. Pelvic Support <ul><li>Pelvic diaphragm is retroperitoneal and supports all the viscera. </li></ul><ul><ul><li>Composed of the: </li></ul></ul><ul><ul><ul><li>Levator ani group: puborectalis, pubococcygeus, and ileococcygeus. </li></ul></ul></ul><ul><ul><ul><li>Coccygeous muscles </li></ul></ul></ul>www.freelivedoctor.com

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